Violation Details: 00357009-AP-307327

Records Request Print
Date
9/25/2024
Report number
00357009-AP-307327
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide service
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(g) and (s)
External site: 411-054-0028(2)
External site: 411-054-0030(1)(e)(A)
Findings
The Alleged Victim (AV) is known to be impatient. AV is a one person assist with transfers. On or about September 25, 2024, AV was being impatient and wanted to go to his/her room. Alleged Perpetrator #2 (AP2) assisted AV to his/her room, where AV requested to be transferred from his/her wheelchair. AP2 did not transfer AV as requested and left AV's room, advising AP2 would return in 5 minutes. After approximately 15 minutes, staff heard AV yelling for help. Staff entered AV's room to find AV on the floor from attempting to self-transfer. AV suffered a bruise to his/her leg/hip area. AP2's failure to provide service as requested to AV placed AV at risk for harm, which is a violation of resident rights, is considered neglect of care and constitutes abuse. The facility's failure to ensure AV's safety is a violation of Oregon Administrative Rules.